The PHC approach: rationale for orienting health systems: country illustrations from Brazil, Ethiopia, Kazakhstan, and Viet Nam (Chapter 4)

"Chapter 4 of the report “Implementing the primary health care (PHC) approach: a primer” captures country illustrations from Brazil, Ethiopia, Kazakhstan, and Viet Nam on the rationale for reorienting health systems towards the PHC approach. The case study from Brazil provides an overview of implementation of the Family Health Strategy over the last two decades, aiming to improve PHC. Positive outcomes include increased life expectancy, socioeconomic benefits, higher registration rates with family health teams, and more preventative healthcare professionals. Challenges include governance structures, leadership, and regional inequalities in resources and access.

The case study from Ethiopia describes the major health sector investments since the 2000s aimed to improve PHC. The Health Extension Programme, launched in 2003, deployed community health workers and constructed new facilities. The Integrated Pharmaceuticals Logistic System supported medicine and vaccine availability. Community participation enhanced service quality. These investments significantly improved health literacy, access, preventative care, maternal and child health, and life expectancy.

The case study from Kazakhstan describes the transformation of the health system to strengthen the PHC approach after the dissolution of the Soviet Union in 1991 by establishing a family medicine-based model in the 1990s and expanding it through programs like the National Programme for Health Care Reform and Development. While health outcomes improved, efforts are needed to enhance equity and prioritize marginalized, poor, and rural communities.

The case study from Viet Nam captures the investment in PHC through political reforms, improving health indicators. They established a network of community health centers, shifted to a social health insurance system, and introduced poverty alleviation measures. These initiatives improved health and access to care, but challenges in equity and people-centeredness remain.